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Ankle Foot Exam Form - ProHealth

Ankle Foot Exam Form - ProHealth 2025

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The document is an Ankle & Foot Exam Form designed for healthcare professionals to assess patients' ankle and foot conditions. It includes sections for patient information, clinical observations, palpation findings, range of motion tests, vascular and neurologic screenings, and orthopedic assessments. The form allows for the documentation of normal findings as well as abnormalities, facilitating a comprehensive evaluation of the patient's lower extremity health.

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Click ‘Get Form’ to open the Ankle Foot Exam Form - ProHealth in the editor.
Begin by entering the patient's name and date at the top of the form. Ensure accuracy as this information is crucial for identification.
Fill in the insurance details and date of birth, selecting M/F for gender. This section helps in processing insurance claims efficiently.
In the 'CC & significant history' section, provide a brief description of the patient's chief complaint and any relevant medical history.
Proceed to complete the fracture screen by checking either 'WNL' (within normal limits) or 'Refer for X-ray', adding any necessary notes.
Continue through each observation and palpation section, marking findings as normal or abnormal, and providing descriptions where applicable.
Finally, review all entries for accuracy before signing and dating the form at the bottom. This ensures that all information is correct and up-to-date.

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How do you check if your foot is fractured?

If you have a broken foot, you may experience some of the following signs and symptoms: Immediate, throbbing pain. Pain that increases with activity and decreases with rest. Swelling. Bruising. Tenderness. Deformity. Difficulty in walking or bearing weight.

What is a physical examination of the feet?

Physical Examination of the Foot The patient is observed from behind while standing on toes; contraction of the gastrocnemius, the degree of heel inversion, the height of the foot arch, and the degree of lateral symmetry are assessed.

What is included in a foot assessment?

Look from the side for the feet arches (is there any pes cavus or pes planus), any swelling or scars. Inspect for any big toe deformity (hallus valgus, hallux valgus interphalangeus or hallus varus), lesser toes deformity (mallet toe, hammer toes, claw toes)[1].

How do you assess your ankle and foot?

If the patient is able to stand: observe in quiet stance and assess weight-bearing distribution; pay attention to foot arches; observe walking with or without assistive device: watch for back deformity: scoliosis, lordosis, kyphosis; observe gait pathology, eg., Trendelenburg; notice any changes in the lower leg

How do you assess a foot fracture?

Imaging tests. If your signs and symptoms suggest a break or fracture, your doctor may suggest one or more of the following imaging tests. X-rays. Most foot fractures can be visualized on X-rays.

What is a physical exam for a foot fracture?

Physical examination for foot fracture includes the following: Inspect injured foot for swelling, bruises, deformity, and open wounds. Uncover uninjured foot for side-by-side comparison. Palpate for pulses, capillary refill, tenderness, instability, and crepitus.

Ankle Foot Exam Form - ProHealth 2025

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